This project will establish a surveillance system for cardiovascular disease in approximately 11 million health maintenance organization (HMO) members. The surveillance system will be initially established for coronary heart disease (CHD), heart failure (HF), and stroke. The broad goals of this project are to: 1. Establish a surveillance system for coronary heart disease (CHD), heart failure (HF) and stroke in the 15 centers of the National Heart Lung and Blood Institute (NHLBI) funded Cardiovascular Disease Research Network including therapeutic interventions, post-event outcomes and important risk factors and confounders. 2. Work collaboratively to establish and implement an aggregate database incorporating coronary heart disease CHD, HF, and stroke data from all 15 CVRN sites that can be used by CVRN investigators and other qualified research scientists to conduct studies related to comparative effectiveness and health disparities. 3. Identify standard criteria for coronary heart disease, heart failure and stroke clinical outcomes, as well as all components noted in goal #1 to enable data aggregation 4. Determine the most recent 10-year trends in the rates of acute myocardial infarction and stroke hospitalization and their relationship to trends in risk factors, co-morbidities, therapeutic interventions, medications, and diagnostic modalities. 5. Demonstrate that the data can be used to address research questions regarding comparative effectiveness and novel methods of monitoring health disparities, areas that have been identified as RC2 topics by NHLBI. This project will result in a surveillance system in a consortium of 15 geographically diverse health plans that provide health care to about 11 million people, nearly 4% of the U.S. population. This surveillance system will be significantly larger than other existing cardiovascular surveillance efforts in the U.S. and includes a population that is diverse in race/ethnicity and sociodemographic characteristics. The surveillance system will include for CHD, HF, and stroke electronically available data on risk factors, co-morbidities, prescription medications, therapeutic interventions, and laboratory testing, and physician and patient characteristics. These data can be utilized to provide timely surveillance reports for CHD, CF, and stroke;a comprehensive description of a patient's longitudinal course both prior to and subsequent to development of CHD, CF, and stroke;and enable research questions to be addressed that assess the relationship of these variables to the course of disease as well as to address research questions relating to comparative effectiveness and to disparities in medical treatment and outcomes. PUBLIC HEALTH RELEVANCE: This project will establish a large database of information about heart disease and stroke in about 11 million members of 15 HMO providers of comprehensive medical care. This information will be used to examine patterns over time in the rates of heart disease and stroke, the first and third leading causes of death in the U.S. These data will enable the medical and public health community to assess progress over time in reducing the rate of these deadly and expensive diseases, to help identify interventions that are effective in preventing heart disease and stroke as well as interventions that favorably impact the lives of those who live with these conditions.